Over-the-Counter Medicine Not the Best Option for Asthma

For the approximately 25 million Americans who have asthma, quick relief medication is a lifeline when breathing becomes difficult. But what many asthma sufferers may not realize is there is a drastic difference between prescription medication and what is available for purchase over the counter.

A University of Florida pilot study found that an over-the-counter asthma medication containing racemic epinephrine was drastically less effective than albuterol, the standard inhaled prescription medication. The study was published online in the Journal of Allergy and Clinical Immunology: In Practice on April 18.

Although albuterol has long been considered the gold standard for quick relief of asthma symptoms, some patients may opt for an over-the-counter alternative for a variety of reasons, such as convenience or because they lack health insurance, said Leslie Hendeles, Pharm.D., a professor in the UF colleges of Pharmacy and Medicine and the senior author of the study.

“It is important for people with chronic asthma to be under the care of a physician and receive an inhaled steroid for prevention of symptoms,” Hendeles said. “If their asthma is under good control, they should not need albuterol more than twice a week.”

Asthma is a chronic disease that causes inflammation in the airways, making breathing difficult at times for those who have it. Patients with asthma use an albuterol inhaler to help open narrow airways and ease breathing when they have symptoms such as coughing or wheezing. Other medications, such as inhaled steroids, also often are used on a daily basis to control the signs and symptoms of asthma.

Dr. Mondal (l) and Hendeles demonstrate an asthmanefrin atomizer, the device that turns the liquid racemic epinephrine into a mist that is inhaled by an asthma patient. The mist can be seen coming from the mouthpiece.

“There is no shortcut method of treating asthma. Asthma is a chronic disease of inflammation,” said Pritish Mondal, M.D., a fellow in the College of Medicine’s department of pediatrics pulmonary and allergy division and the first author of the paper. “The progression of the disease should be assessed by medical personnel from time to time. Secondly, overuse of quick relief medication, whether prescription or nonprescription, has the potential to harm asthma patients because it can suppress the signs and symptoms, so that they only come to medical attention when the condition is really bad. We don’t want that.”

UF researchers studied the active ingredient in a product called Asthmanefrin, which is marketed by Nephron Pharmaceuticals Corp. To obtain their findings, UF researchers tested what happened when patients received a standard dose of albuterol or racemic epinephrine at four different strengths prior to giving them a second medication, methacholine, which would safely narrow their airways. This allowed them to test how well the medications protected the lungs, which is an accurate test of how well some asthma treatments work, Hendeles said.

According to the findings, albuterol worked markedly better to protect the airways than racemic epinephrine — even when twice the dose of the over-the-counter medicine was given.

“This product is only for the transient relief of mild asthma symptoms. If someone cannot afford preventive medications, they might use an over-the-counter medication instead. The problem is you are not treating the inflammation, you are just temporarily opening up the airways. A patient could die from undertreatment,” Hendeles said.

Although the research shows albuterol is vastly superior in relieving asthma symptoms, there is a place for over-the-counter asthma medicines, Hendeles said.

“These products are good if you have mild intermittent asthma and run out of your prescribed medication or are traveling and you forgot your albuterol inhaler. There is a rationale for someone in those circumstances to access this,” he said. “But it is important people don’t use this on a regular basis. These are only for occasional use for mild symptoms.”